382. Novel Influenza A/H1N1/2009 viral infection in pregnancy: A case report from Singapore

Abstract

Seasonal Influenza is common in Singapore, a tropical country, with two peaks a year(April–June and year end). The novel influenza A virus is easily transmissible via respiratory droplets. High-risk population include the elderly, children, and pregnant mothers. The patient was a 40-year-old Malay lady, G5P4, a chronic hypertensive not compliant with medications. She presented at 37-weeks gestation to the emergency room with a 2-day history of hyperpyrexia, breathlessness, flu-like symptoms, and decreased fetal movement. Her vital signs were pulse rate 110, respiratory rate 20, blood pressure 190/110, temperature 39.8 °C and oxygen saturation 94–96%. On examination, her throat was injected and she had bilateral lung crepitations. Her white cell count was 14.67, CRP 64. Chest X-ray revealed patchy alveolar shadowing in the right lower zone suggestive of pneumonia. Uric acid was 594, aspartate transaminase was 84 and urine PCR was 0.3. CTG showed fetal tachycardia of 170 with poor variability. She was admitted to the high dependency labour ward for severe pre-eclampsia and possible chest infection. High flow oxygen was given together with Ceftriaxone, Azithromycin for possible chest infection and Labetalol for blood pressure control. Respiratory throat swabs were sent for Influenza A PCR and tested positive for Novel Influenza A/H1N1/2009. She was referred to Infectious Disease physicians and started on Oseltamivir. IV Magnesium Sulphate was started for her severe pre-eclampsia and she underwent induction of labour. She delivered vaginally and the newborn was admitted to high dependency neonatal ward. The patient was admitted for a total of 6 days. Pregnant women, especially those with comorbidities, are at higher risk of influenza infections, resulting in increased morbidity and mortality to mother and her newborn. Despite convincing evidence of both safety and benefit of influenza vaccination, vaccination rates among pregnant women remain low. Education of pregnant mothers and healthcare workers are essential.